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SHANELLE JACKSON MD
NPI 1962295949
Student in an Organized Health Care Education/Training Program in Los Angeles, CA

Active since May 23, 2025
1731 E 120TH ST, LOS ANGELES, CA 90059(323) 563-4800 Get Directions Write a Review

NPPES record last updated: April 20, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 20, 2026, May 23, 2025 (2 updates tracked since 2025).

About Shanelle Jackson Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANELLE JACKSON MD (NPI 1962295949) is an individual student in an organized health care education/training program in Los Angeles, California, licensed in Michigan (4351055023) and active in the NPI registry since May 2025.

NPPES Registry Identity

NPI1962295949
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameSHANELLE JACKSONCredential: MD
Location Address1731 E 120TH STLos Angeles, CA 90059-3051
Mailing Address1731 E 120th StLos Angeles, CA 90059-3051 · (323) 563-4800
Phone(323) 563-4800
Sole ProprietorNo
Enumeration DateMay 23, 2025
Last NPPES UpdateApril 20, 20262 updates tracked since enumeration
NPPES CertifiedApril 20, 2026
✔ NPI 1962295949 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
License✔ Licensed in MI · 4351055023
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1731 E 120TH ST, Los Angeles, CA 90059
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MADISON KAUANOE WILLIAMS MD
Psychiatry & Neurology (Psychiatry)
1731 E 120TH ST
LOS ANGELES, CA 90059
Los Angeles County (323) 563-4800
CHRIS NOLASCO
Student in an Organized Health Care Education/Training Program
1731 E 120TH ST
LOS ANGELES, CA 90059
Los Angeles County (323) 568-3347
SAMUEL KIM MD
Student in an Organized Health Care Education/Training Program
1731 E 120TH ST
LOS ANGELES, CA 90059
Los Angeles County (323) 563-2480
KATIA CAMPOS
Student in an Organized Health Care Education/Training Program
1731 E 120TH ST
LOS ANGELES, CA 90059
Los Angeles County (323) 563-4800
TIFFANY MOLINA TAN
Student in an Organized Health Care Education/Training Program
1731 E 120TH ST
LOS ANGELES, CA 90059
Los Angeles County (323) 563-4800
JASMINE ALEXANDRIA HOLLOWAY
Physician Assistant
1731 E 120TH ST
LOS ANGELES, CA 90059
Los Angeles County (323) 563-4800
SHARDAE BLANDIN
Physician Assistant
1731 E 120TH ST
LOS ANGELES, CA 90059
Los Angeles County (323) 563-4800
BRIAN GIOVANNI MONTANO
Student in an Organized Health Care Education/Training Program
1731 E 120TH ST
LOS ANGELES, CA 90059
Los Angeles County (323) 563-4800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shanelle Jackson's NPI number?

The NPI number for Shanelle Jackson is 1962295949. It was assigned to this individual provider in the NPPES registry on May 23, 2025.

Where is Shanelle Jackson located?

Shanelle Jackson practices at 1731 E 120th St, Los Angeles, CA 90059. The listed phone number is (323) 563-4800.

What is Shanelle Jackson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Shanelle Jackson was last updated on April 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.